INDEX Interstate Medical Licensure Compact (October 27, 2015)

Section 1 Purpose

Section 13 Financial Powers

Section 2 Definitions Physician eligibility for participation in compact

Section 14 Organization and operation of the Interstate Commission

Section 3 Alternative for licensure if physician does not meet eligibility requirements

Section 15 Rulemaking functions of the Interstate Commission

Section 4 Designation of state of principal license

Section 16 Oversight of Interstate Compact

Section 5 Application and issuance of expedited licensure

Section 17 Enforcement of Interstate Compact

Section 6 Fees for expedited licensure

Section 18 Default procedures

Section 7 Renewal and continued participation

Section 19 Dispute resolution

Section 8 Coordinated information system

Section 20 Member states, effective date, and amendment

Section 9 Joint investigations

Section 21 Withdrawal

Section 10 Disciplinary actions

Section 22 Dissolution

Section 11 Interstate Medical Licensure Compact Commission

Section 23 Severability and construction

Section 12 Powers and duties of the Interstate Commission

Section 24 Binding effect of Compact and other laws

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INTERSTATE MEDICAL LICENSURE COMPACT 1

SECTION 1. PURPOSE 2

In order to strengthen access to health care, and in recognition of the advances in the 3

delivery of health care, the member states of the Interstate Medical Licensure Compact 4

have allied in common purpose to develop a comprehensive process that complements 5

the existing licensing and regulatory authority of state medical boards, provides a 6

streamlined process that allows physicians to become licensed in multiple states, 7

thereby enhancing the portability of a medical license and ensuring the safety of 8

patients. The Compact creates another pathway for licensure and does not otherwise 9

change a state’s existing Medical Practice Act. The Compact also adopts the prevailing 10

standard for licensure and affirms that the practice of medicine occurs where the patient 11

is located at the time of the physician-patient encounter, and therefore, requires the 12

physician to be under the jurisdiction of the state medical board where the patient is 13

located. State medical boards that participate in the Compact retain the jurisdiction to 14

impose an adverse action against a license to practice medicine in that state issued to a 15

physician through the procedures in the Compact. 16

SECTION 2. DEFINITIONS 17

In this compact: 18

(a) “Bylaws” means those bylaws established by the Interstate Commission 19

pursuant to Section 11. 20

(b) “Commissioner” means the voting representative appointed by each 21

member board pursuant to Section 11. 22

(c) “Conviction” means a finding by a court that an individual is guilty of a 23

criminal offense through adjudication, or entry of a plea of guilt or no contest to the 24

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charge by the offender. Evidence of an entry of a conviction of a criminal offense by the 25

court shall be considered final for purposes of disciplinary action by a member board. 26

(d) “Expedited License” means a full and unrestricted medical license granted 27

by a member state to an eligible physician through the process set forth in the Compact. 28

(e) “Interstate Commission” means the interstate commission created 29

pursuant to Section 11. 30

(f) “License” means authorization by a member state for a physician to 31

engage in the practice of medicine, which would be unlawful without authorization. 32

(g) “Medical Practice Act” means laws and regulations governing the practice 33

of allopathic and osteopathic medicine within a member state. 34

(h) “Member Board” means a state agency in a member state that acts in the 35

sovereign interests of the state by protecting the public through licensure, regulation, 36

and education of physicians as directed by the state government. 37

(i) “Member State” means a state that has enacted the Compact. 38

(j) “Practice of Medicine” means that clinical prevention, diagnosis, or 39

treatment of human disease, injury, or condition requiring a physician to obtain and 40

maintain a license in compliance with the Medical Practice Act of a member state. 41

(k) “Physician” means any person who: 42

1) Is a graduate of a medical school accredited by the Liaison 43

Committee on Medical Education, the Commission on Osteopathic College 44

Accreditation, or a medical school listed in the International Medical Education Directory 45

or its equivalent; 46

2) Passed each component of the United State Medical Licensing 47

Examination (USMLE) or the Comprehensive Osteopathic Medical Licensing 48

Examination (COMLEX-USA) within three attempts, or any of its predecessor 49

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examinations accepted by a state medical board as an equivalent examination for 50

licensure purposes; 51

3) Successfully completed graduate medical education approved by 52

the Accreditation Council for Graduate Medical Education or the American Osteopathic 53

Association; 54

4) Holds specialty certification or a time-unlimited specialty certificate 55

recognized by the American Board of Medical Specialties or the American Osteopathic 56

Association’s Bureau of Osteopathic Specialists; 57

5) Possesses a full and unrestricted license to engage in the practice 58

of medicine issued by a member board; 59

6) Has never been convicted, received adjudication, deferred 60

adjudication, community supervision, or deferred disposition for any offense by a court 61

of appropriate jurisdiction; 62

7) Has never held a license authorizing the practice of medicine 63

subjected to discipline by a licensing agency in any state, federal, or foreign jurisdiction, 64

excluding any action related to non-payment of fees related to a license; 65

8) Has never had a controlled substance license or permit suspended 66

or revoked by a state or the United States Drug Enforcement Administration; and 67

9) Is not under active investigation by a licensing agency or law 68

enforcement authority in any state, federal, or foreign jurisdiction. 69

(l) “Offense” means a felony, gross misdemeanor, or crime of moral 70

turpitude. 71

(m) “Rule” means a written statement by the Interstate Commission 72

promulgated pursuant to Section 12 of the Compact that is of general applicability, 73

implements, interprets, or prescribes a policy or provision of the Compact, or an 74

organizational, procedural, or practice requirement of the Interstate Commission, and 75

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has the force and effect of statutory law in a member state, and includes the 76

amendment, repeal, or suspension of an existing rule. 77

(n) “State” means any state, commonwealth, district, or territory of the United 78

States. 79

(o) “State of Principal License” means a member state where a physician 80

holds a license to practice medicine and which has been designated as such by the 81

physician for purposes of registration and participation in the Compact. 82

SECTION 3. ELIGIBILITY 83

(a) A physician must meet the eligibility requirements as defined in Section 84

2(k) to receive an expedited license under the terms and provisions of the Compact. 85

(b) A physician who does not meet the requirements of Section 2(k) may 86

obtain a license to practice medicine in a member state if the individual complies with all 87

laws and requirements, other than the Compact, relating to the issuance of a license to 88

practice medicine in that state. 89

SECTION 4. DESIGNATION OF STATE OF PRINICIPAL LICENSE 90

(a) A physician shall designate a member state as the state of principal 91

license for purposes of registration for expedited licensure through the Compact if the 92

physician possesses a full and unrestricted license to practice medicine in that state, 93

and the state is: 94

1) The state of principal residence for the physician, or 95

2) The state where at least 25% of the practice of medicine occurs, or 96

3) The location of the physician’s employer, or 97

4) If no state qualifies under subsection (1), subsection (2), or 98

subsection (3), the state designated as state of residence for purpose of federal income 99

tax. 100

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(b) A physician may redesignate a member state as state of principal license 101

at any time, as long as the state meets the requirements of subsection (a). 102

(c) The Interstate Commission is authorized to develop rules to facilitate 103

redesignation of another member state as the state of principal license. 104

SECTION 5. APPLICATION AND ISSUANCE OF EXPEDITED LICENSURE 105

(a) A physician seeking licensure through the Compact shall file an 106

application for an expedited license with the member board of the state selected by the 107

physician as the state of principal license. 108

(b) Upon receipt of an application for an expedited license, the member board 109

within the state selected as the state of principal license shall evaluate whether the 110

physician is eligible for expedited licensure and issue a letter of qualification, verifying or 111

denying the physician’s eligibility, to the Interstate Commission. 112

1) Static qualifications, which include verification of medical education, 113

graduate medical education, results of any medical or licensing examination, and other 114

qualifications as determined by the Interstate Commission through rule, shall not be 115

subject to additional primary source verification where already primary source verified 116

by the state of principal license. 117

2) The member board within the state selected as the state of 118

principal license shall, in the course of verifying eligibility, perform a criminal background 119

check of an applicant, including the use of the results of fingerprint or other biometric 120

data checks compliant with the requirements of the Federal Bureau of Investigation, 121

with the exception of federal employees who have suitability determination in 122

accordance with 5 C.F.R. §731.202. 123

3) Appeal on the determination of eligibility shall be made to the 124

member state where the application was filed and shall be subject to the law of that 125

state. 126

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(c) Upon verification in subsection (b), physicians eligible for an expedited 127

license shall complete the registration process established by the Interstate 128

Commission to receive a license in a member state selected pursuant to subsection (a), 129

including the payment of any applicable fees. 130

(d) After receiving verification of eligibility under subsection (b) and any fees 131

under subsection (c), a member board shall issue an expedited license to the physician. 132

This license shall authorize the physician to practice medicine in the issuing state 133

consistent with the Medical Practice Act and all applicable laws and regulations of the 134

issuing member board and member state. 135

(e) An expedited license shall be valid for a period consistent with the 136

licensure period in the member state and in the same manner as required for other 137

physicians holding a full and unrestricted license within the member state. 138

(f) An expedited license obtained through the Compact shall be terminated if 139

a physician fails to maintain a license in the state of principal licensure for a non-140

disciplinary reason, without redesignation of a new state of principal licensure. 141

(g) The Interstate Commission is authorized to develop rules regarding the 142

application process, including payment of any applicable fees, and the issuance of an 143

expedited license. 144

SECTION 6. FEES FOR EXPEDITED LICENSURE 145

(a) A member state issuing an expedited license authorizing the practice of 146

medicine in that state may impose a fee for a license issued or renewed through the 147

Compact. 148

(b) The Interstate Commission is authorized to develop rules regarding fees 149

for expedited licenses. 150

SECTION 7. RENEWAL AND CONTINUED PARTICIPATION 151

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(a) A physician seeking to renew an expedited license granted in a member 152

state shall complete a renewal process with the Interstate Commission if the physician: 153

1) Maintains a full and unrestricted license in a state of principal 154

license; 155

2) Has not been convicted, received adjudication, deferred 156

adjudication, community supervision, or deferred disposition for any offense by a court 157

of appropriate jurisdiction; 158

3) Has not had a license authorizing the practice of medicine subject 159

to discipline by a licensing agency in any state, federal, or foreign jurisdiction, excluding 160

any action related to non-payment of fees related to a license; and 161

4) Has not had a controlled substance license or permit suspended or 162

revoked by a state or the United States Drug Enforcement Administration. 163

(b) Physicians shall comply with all continuing professional development or 164

continuing medical education requirements for renewal of a license issued by a member 165

state. 166

(c) The Interstate Commission shall collect any renewal fees charged for the 167

renewal of a license and distribute the fees to the applicable member board. 168

(d) Upon receipt of any renewal fees collected in subsection (c), a member 169

board shall renew the physician’s license. 170

(e) Physician information collected by the Interstate Commission during the 171

renewal process will be distributed to all member boards. 172

(f) The Interstate Commission is authorized to develop rules to address 173

renewal of licenses obtained through the Compact. 174

SECTION 8. COORDINATED INFORMATION SYSTEM 175

(a) The Interstate Commission shall establish a database of all physicians 176

licensed, or who have applied for licensure, under Section 5. 177

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(b) Notwithstanding any other provision of law, member boards shall report to 178

the Interstate Commission any public action or complaints against a licensed physician 179

who has applied or received an expedited license through the Compact. 180

(c) Member boards shall report disciplinary or investigatory information 181

determined as necessary and proper by rule of the Interstate Commission. 182

(d) Member boards may report any non-public complaint, disciplinary, or 183

investigatory information not required by subsection (c) to the Interstate Commission. 184

(e) Member boards shall share complaint or disciplinary information about a 185

physician upon request of another member board. 186

(f) All information provided to the Interstate Commission or distributed by 187

member boards shall be confidential, filed under seal, and used only for investigatory or 188

disciplinary matters. 189

(g) The Interstate Commission is authorized to develop rules for mandated or 190

discretionary sharing of information by member boards. 191

SECTION 9. JOINT INVESTIGATIONS 192

(a) Licensure and disciplinary records of physicians are deemed investigative. 193

(b) In addition to the authority granted to a member board by its respective 194

Medical Practice Act or other applicable state law, a member board may participate with 195

other member boards in joint investigations of physicians licensed by the member 196

boards. 197

(c) A subpoena issued by a member state shall be enforceable in other 198

member states. 199

(d) Member boards may share any investigative, litigation, or compliance 200

materials in furtherance of any joint or individual investigation initiate under the 201

Compact. 202

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(e) Any member state may investigate actual or alleged violations of the 203

statutes authorizing the practice of medicine in any other member state in which a 204

physician holds a license to practice medicine. 205

SECTION 10. DISCIPLINARY ACTIONS 206

(a) Any disciplinary action taken by any member board against a physician 207

licensed through the Compact shall be deemed unprofessional conduct which may be 208

subject to discipline by other member boards, in addition to any violation of the Medical 209

Practice Act or regulations in that state. 210

(b) If a license granted to a physician by the member board in the state of 211

principal license is revoked, surrendered or relinquished in lieu of discipline, or 212

suspended, then all licenses issued to the physician by member boards shall 213

automatically be placed, without further action necessary by any member board, on the 214

same status. If the member board in the state of principal license subsequently 215

reinstates the physician’s license, a license issued to the physician by any other 216

member board shall remain encumbered until that respective member board takes 217

action to reinstate the license in a manner consistent with the Medical Practice Act of 218

that state. 219

(c) If disciplinary action is taken against a physician by a member board not in 220

the state of principal license, any other member board may deem the action conclusive 221

as to matter of law and fact decided, and: 222

1) Impose the same or lesser sanction(s) against the physician so 223

long as such sanctions are consistent with the Medical Practice Act of that state; or 224

2) Pursue separate disciplinary action against the physician under its 225

respective Medical Practice Act, regardless of the action taken in other member states. 226

(d) If a license granted to a physician by a member board is revoked, 227

surrendered or relinquished in lieu of discipline, or suspended, then any license(s) 228

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issued to the physician by any other member board(s) shall be suspended, 229

automatically and immediately without further action necessary by the other member 230

board(s), for ninety (90) days upon entry of the order by the disciplining board, to permit 231

the member board(s) to investigate the basis for the action under the Medical Practice 232

Act of that state. A member board may terminate the automatic suspension of the 233

license it issued prior to the completion of the ninety (90) day suspension period in a 234

manner consistent with the Medical Practice Act of that state. 235

SECTION 11. INTERSTATE MEDICAL LICENSURE COMPACT COMMISSION 236

(a) The member states hereby create the “Interstate Medical Licensure 237

Compact Commission”. 238

(b) The purpose of the Interstate Commission is the administration of the 239

Interstate Medical Licensure Compact, which is a discretionary state function. 240

(c) The Interstate Commission shall be a body corporate and joint agency of 241

the member states and shall have all the responsibilities, powers, and duties set forth in 242

the Compact, and such additional powers as may be conferred upon it by a subsequent 243

concurrent action of the respective legislatures of the member states in accordance with 244

the terms of the Compact. 245

(d) The Interstate Commission shall consist of two voting representatives 246

appointed by each member state who shall serve as Commissioners. In states where 247

allopathic and osteopathic physicians are regulated by separate member boards, or if 248

the licensing and disciplinary authority is split between separate member boards, or if 249

the licensing and disciplinary authority is split between multiple member boards within a 250

member state, the member state shall appoint one representative from each member 251

board. A Commissioner shall be a(n): 252

1) Allopathic or osteopathic physician appointed to a member board; 253

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2) Executive director, executive secretary, or similar executive of a 254

member board; or 255

3) Member of the public appointed to a member board. 256

(e) The Interstate Commission shall meet at least once each calendar year. 257

A portion of this meeting shall be a business meeting to address such matters as may 258

properly come before the Commission, including the election of officers. The 259

chairperson may call additional meetings and shall call for a meeting upon the request 260

of a majority of the member states. 261

(f) The bylaws may provide for meetings of the Interstate Commission to be 262

conducted by telecommunication or electronic communication. 263

(g) Each Commissioner participating at a meeting of the Interstate 264

Commission is entitled to one vote. A majority of Commissioners shall constitute a 265

quorum for the transaction of business, unless a larger quorum is required by the 266

bylaws of the Interstate Commission. A Commission shall not delegate a vote to 267

another Commissioner. In the absence of its Commissioner, a member state may 268

delegate voting authority for a specified meeting to another person from that state who 269

shall meet the requirements of subsection (d). 270

(h) The Interstate Commission shall provide public notice of all meetings and 271

all meetings shall be open to the public. The Interstate Commission may close a 272

meeting, in full or in portion, where it determines by a two-thirds vote of the 273

Commissioners present that an open meeting would be likely to: 274

1) Relate solely to the internal personnel practice and procedures of 275

the Interstate Commission; 276

2) Discuss matters specifically exempted from disclosure by federal 277

statute; 278

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3) Discuss trade secrets, commercial, or financial information that is 279

privileged or confidential; 280

4) Involve accusing a person of a crime, or formally censuring a 281

person; 282

5) Discuss information of a personal nature where disclosure would 283

constitute a clearly unwarranted invasion of personal privacy; 284

6) Discuss investigative records compiled for law enforcement 285

purposes; or 286

7) Specifically relate to the participation in a civil action or other legal 287

proceeding. 288

(i) The Interstate Commission shall keep minutes which shall fully describe 289

all matters discussed in a meeting and shall provide a full and accurate summary of 290

actions taken, including record of any roll call votes. 291

(j) The Interstate Commission shall make its information and official records, 292

to the extent not otherwise designated in the Compact or by its rules, available to the 293

public for inspection. 294

(k) The Interstate Commission shall establish an executive committee, which 295

shall include officers, members, and others as determined by the bylaws. The 296

executive committee shall have the power to act on behalf of the Interstate Commission, 297

with the exception of rulemaking, during periods when the Interstate Commission is not 298

in session. When acting on behalf of the Interstate Commission, the executive 299

committee shall oversee the administration of the Compact including enforcement and 300

compliance with the provisions of the Compact, its bylaws and rules, and other such 301

duties as necessary. 302

(l) The Interstate Commission shall establish other committees for 303

governance and administration of the Compact. 304

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SECTION 12. POWERS AND DUTIES OF THE INTERSTATE COMMISSION 305

(a) Oversee and maintain the administration of the Compact; 306

(b) Promulgate rules which shall be binding to the extent and in the manner 307

provided for in the Compact; 308

(c) Issue, upon the request of a member state or member board, advisory 309

opinions concerning the meaning or interpretation of the Compact, its bylaws, rules, and 310

actions; 311

(d) Enforce compliance with Compact provisions, the rules promulgated by 312

the Interstate Commission, and the bylaws, using all necessary and proper means, 313

including but not limited to the use of judicial process; 314

(e) Establish and appoint committees including, but not limited to, an 315

executive committee as required by Section 11, which shall have the power to act on 316

behalf of the Interstate Commission in carrying out its powers and duties; 317

(f) Pay, or provide for the payment of the expenses related to the 318

establishment, organization, and ongoing activities of the Interstate Commission; 319

(g) Establish and maintain one or more offices; 320

(h) Borrow, accept, hire, or contract for services of personnel; 321

(i) Purchase and maintain insurance and bonds; 322

(j) Employ an executive director who shall have such powers to employ, 323

select or appoint employees, agents, or consultants, and to determine their 324

qualifications, define their duties, and fix their compensation; 325

(k) Establish personnel policies and programs relating to conflicts of interest, 326

rates of compensation, and qualifications of personnel; 327

(l) Accept donations and grants of money, equipment, supplies, materials, 328

and services and to receive, utilize, and dispose of it in a manner consistent with the 329

conflict of interest policies established by the Interstate Commission; 330

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(m) Lease, purchase, accept contributions or donations of, or otherwise to 331

own, hold, improve or use, any property, real, personal, or mixed; 332

(n) Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise 333

dispose of any property, real, personal, or mixed; 334

(o) Establish a budget and make expenditures; 335

(p) Adopt a seal and bylaws governing the management and operation of the 336

Interstate Commission; 337

(q) Report annually to the legislatures and governors of the member states 338

concerning the activities of the Interstate Commission during the preceding year. Such 339

reports shall also include reports of financial audits and any recommendations that may 340

have been adopted by the Interstate Commission; 341

(r) Coordinate education, training, and public awareness regarding the 342

Compact, its implementation, and its operation; 343

(s) Maintain records in accordance with the bylaws; 344

(t) Seek and obtain trademarks, copyrights, and patents; and 345

(u) Perform such functions as may be necessary or appropriate to achieve the 346

purpose of the Compact. 347

SECTION 13. FINANCE POWERS 348

(a) The Interstate Commission may levy on and collect an annual assessment 349

from each member state to cover the cost of the operations and activities of the 350

Interstate Commission and its staff. The total assessment must be sufficient to cover 351

the annual budget approved each year for which revenue is not provided by other 352

sources. The aggregate annual assessment amount shall be allocated upon a formula 353

to be determined by the Interstate Commission, which shall promulgate a rule binding 354

upon all member states. 355

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(b) The Interstate Commission shall not incur obligations of any kind prior to 356

securing the funds adequate to meet the same. 357

(c) The Interstate Commission shall not pledge the credit of any of the 358

member states, except by, and with the authority of, the member state. 359

(d) The Interstate Commission shall be subject to a yearly financial audit 360

conducted by a certified or licensed accountant and the report of the audit shall be 361

included in the annual report of the Interstate Commission. 362

SECTION 14. ORGANIZATION AND OPERATION OF THE INTERSTATE 363

COMMISSION 364

(a) The Interstate Commission shall, by a majority of Commissioners present 365

and voting, adopt bylaws to govern its conduct as may be necessary or appropriate to 366

carry out the purposes of the Compact within twelve (12) months of the first Interstate 367

Commission meeting. 368

(b) The Interstate Commission shall elect or appoint annually from among its 369

Commissioners a chairperson, a vice-chairperson, and a treasurer, each of whom shall 370

have such authority and duties as may be specified in the bylaws. The chairperson, or 371

in the chairperson’s absence or disability, the vice-chairperson, shall preside at all 372

meetings of the Interstate Commission. 373

(c) Officers selected in subsection (b) shall serve without remuneration for the 374

Interstate Commission. 375

(d) The officers and employees of the Interstate Commission shall be immune 376

from suit and liability, either personally or in their official capacity, for a claim for damage 377

to or loss of property or personal injury or other civil liability caused or arising out of, or 378

relating to, an actual or alleged act, error, or omission that occurred, or that such person 379

had a reasonable basis for believing occurred, within the scope of Interstate 380

Commission employment, duties, or responsibilities; provided that such person shall not 381

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be protected from suit or liability for damage, loss, injury, or liability caused by the 382

intentional or willful and wanton misconduct of such person. 383

(e) The liability of the executive director and employees of the Interstate 384

Commission or representatives of the Interstate Commission, acting within the scope of 385

such person’s employment or duties for acts, errors, or omissions occurring within such 386

person’s state, may not exceed the limits of liability set forth under the constitution and 387

laws of that state for state officials, employees, and agents. The Interstate Commission 388

is considered to be an instrumentality of the states for the purpose of any such action. 389

Nothing in this subsection shall be construed to protect such person from suit or liability 390

for damage, loss, injury, or liability caused by the intentional or willful and wanton 391

misconduct of such person. 392

(f) The Interstate Commission shall defend the executive director, its 393

employees, and subject to the approval of the attorney general or other appropriate 394

legal counsel of the member state represented by an Interstate Commission 395

representative, shall defend such Interstate Commission representative in any civil 396

action seeking to impose liability arising out of an actual or alleged act, error or omission 397

that occurred within the scope of Interstate Commission employment, duties or 398

responsibilities, or that the defendant had a reasonable basis for believing occurred 399

within the scope of Interstate Commission employment, duties, or responsibilities, 400

provided that the actual or alleged act, error, or omission did not result from intentional 401

or willful and wanton misconduct on the part of such person. 402

(g) To the extent not covered by the state involved, member state, or the 403

Interstate Commission, the representatives or employees of the Interstate Commission 404

shall be held harmless in the amount of a settlement or judgement, including attorney’s 405

fees and costs, obtained against such persons arising out of an actual or alleged act, 406

error, or omission that occurred within the scope of the Interstate Commission 407

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employment, duties, or responsibilities, or that such persons had a reasonable basis for 408

believing occurred within the scope of Interstate Commission employment, duties, or 409

responsibilities, provided that the actual or alleged act, error, or omission did not result 410

from intentional or willful and wanton misconduct on the part of such person. 411

SECTION 15. RULEMAKING FUNCTIONS OF THE INTERSTATE 412

COMMISSION 413

(a) The Interstate Commission shall promulgate reasonable rules in order to 414

effectively and efficiently achieve the purpose of the Compact. Notwithstanding the 415

foregoing, in the event the Interstate Commission exercises its rulemaking authority in a 416

manner that is beyond the scope of the purposes of the Compact, or the powers 417

granted hereunder, then such an action by the Interstate Commission shall be invalid 418

and have no force or effect. 419

(b) Rules deemed appropriate for the operations of the Interstate Commission 420

shall be made pursuant to a rulemaking process that substantially conforms to the 421

“Model State Administrative Procedure Act” of 2010, and subsequent amendments 422

thereto. 423

(c) Not later than thirty (30) days after a rule is promulgated, any person may 424

file a petition for judicial review of the rule in the United States District Court for the 425

District of Columbia or the federal district where the Interstate Commission has its 426

principal offices, provided that the filing of such a petition shall not stay or otherwise 427

prevent the rule from becoming effective unless the court finds that the petitioner has a 428

substantial likelihood of success. The court shall give deference to the actions of the 429

Interstate Commission consistent with applicable law and shall not find the rule to be 430

unlawful if the rule represents a reasonable exercise of the authority granted to the 431

Interstate Commission. 432

SECTION 16. OVERSIGHT OF INTERSTATE COMPACT 433

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(a) The executive, legislative, and judicial branches of state government in 434

each member state shall enforce the Compact and shall take all actions necessary and 435

appropriate to effectuate the Compact’s purposes and intent. The provisions of the 436

Compact and the rules promulgated hereunder shall have standing as statutory law but 437

shall not override existing state authority to regulate the practice of medicine. 438

(b) All courts shall take judicial notice of the Compact and the rules in any 439

judicial or administrative proceeding in a member state pertaining to the subject matter 440

of the Compact which may affect the powers, responsibilities or actions of the Interstate 441

Commission. 442

(c) The Interstate Commission shall be entitled to receive all services of 443

process in any such proceeding, and shall have standing to intervene in the proceeding 444

for all purposes. Failure to provide service of process to the Interstate Commission 445

shall render a judgment or order void as to the Interstate Commission, the Compact, or 446

promulgated rules. 447

SECTION 17. ENFORCEMENT OF INTERSTATE COMPACT 448

(a) The Interstate Commission, in the reasonable exercise of its discretion, 449

shall enforce the provisions and rules of the Compact. 450

(b) The Interstate Commission may, by majority vote of the Commissioners, 451

initiate legal action in the United States Court for the District of Columbia, or, at the 452

discretion of the Interstate Commission, in the federal district where the Interstate 453

Commission has its principal offices, to enforce compliance with the provisions of the 454

Compact, and its promulgated rules and bylaws, against a member state in default. The 455

relief sought may including both injunctive relief and damages. In the event judicial 456

enforcement is necessary, the prevailing party shall be awarded all costs of such 457

litigation including reasonable attorney’s fees. 458

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(c) The remedies herein shall not be the exclusive remedies of the Interstate 459

Commission. The Interstate Commission may avail itself of any other remedies 460

available under state law or regulation of a profession. 461

SECTION 18. DEFAULT PROCEDURES 462

(a) The grounds for default include, but are not limited to, failure of a member 463

state to perform such obligations or responsibilities imposed upon it by the Compact, or 464

the rules and bylaws of the Interstate Commission promulgated under the Compact. 465

(b) If the Interstate Commission determines that a member state has 466

defaulted in the performance of its obligations or responsibilities under the Compact, or 467

the bylaws or promulgated rules, the Interstate Commission shall: 468

1) Provide written notice to the defaulting state and other member 469

states, of the nature of the default, the means of curing the default, and any action taken 470

by the Interstate Commission. The Interstate Commission shall specify the conditions 471

by which the defaulting state must cure its default; and 472

2) Provide remedial training and specific technical assistance 473

regarding the default. 474

(c) If the defaulting state fails to cure the default, the defaulting state shall be 475

terminated from the Compact upon an affirmative vote of a majority of the 476

Commissioners and all rights, privileges, and benefits conferred by the Compact shall 477

terminate on the effective date of termination. A cure of the default does not relieve the 478

offending state of obligations or liabilities incurred during the period of the default. 479

(d) Termination of membership in the Compact shall be imposed only after all 480

other means of securing compliance have been exhausted. Notice of intent to terminate 481

shall be given by the Interstate Commission to the governor, the majority and minority 482

leaders of the defaulting state’s legislature, and each of the member states. 483

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(e) The Interstate Commission shall establish rules and procedures to 484

address licenses and physicians that are materially impacted by the termination of a 485

member state, or the withdrawal of a member state. 486

(f) The member state which has been terminated is responsible for all due, 487

obligations, and liabilities incurred through the effective date of termination including 488

obligations, the performance of which extends beyond the effective date of termination. 489

(g) The Interstate Commission shall not bear any costs relating to any state 490

that has been found to be in default or which has been terminated from the Compact, 491

unless otherwise mutually agreed upon in writing between the Interstate Commission 492

and the defaulting state. 493

(h) The defaulting state may appeal the action of the Interstate Commission 494

by petitioning the United States District Court for the District of Columbia or the federal 495

district where the Interstate Commission has its principal offices. The prevailing party 496

shall be awarded all costs of such litigation including reasonable attorney’s fees. 497

SECTION 19. DISPUTE RESOLUTION 498

(a) The Interstate Commission shall attempt, upon the request of a member 499

state, to resolve disputes which are subject to the Compact and which may arise among 500

member states or member boards. 501

(b) The Interstate Commission shall promulgate rules providing for both 502

mediation and binding dispute resolution as appropriate. 503

SECTION 20. MEMBER STATES, EFFECTIVE DATE AND AMENDMENT 504

(a) Any state is eligible to become a member of the Compact. 505

(b) The Compact shall become effective and binding upon legislative 506

enactment of the Compact into law by no less than seven (7) states. Thereafter, it shall 507

become effective and binding on a state upon enactment of the Compact into law by 508

that state. 509

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(c) The governors of non-member states, or their designees, shall be invited 510

to participate in the activities of the Interstate Commission on a non-voting basis prior to 511

adoption of the Compact by all states. 512

(d) The Interstate Commission may propose amendments to the Compact for 513

enactment by the member states. No amendment shall become effective and binding 514

upon the Interstate Commission and the member states unless and until it is enacted 515

into law by unanimous consent of the member states. 516

SECTION 21. WITHDRAWAL 517

(a) Once effective, the Compact shall continue in force and remain binding 518

upon each and every member state; provided that a member state may withdraw from 519

the Compact by specifically repealing the statute which enacted the Compact into law. 520

(b) Withdrawal from the Compact shall be by the enactment of a statute 521

repealing the same, but shall not take effect until one (1) year after the effective date of 522

such statute and until written notice of the withdrawal has been given by the 523

withdrawing state to the governor of each other member state. 524

(c) The withdrawing state shall immediately notify the chairperson of the 525

Interstate Commission in writing upon the introduction of legislation repealing the 526

Compact in the withdrawing state. 527

(d) The Interstate Commission shall notify the other member states of the 528

withdrawing state’s intent to withdraw within sixty (60) days of its receipt of notice 529

provided under subsection (c). 530

(e) The withdrawing state is responsible for all dues, obligations and liabilities 531

incurred through the effective date of withdrawal, including obligations, the performance 532

of which extend beyond the effective date of withdrawal. 533

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(f) Reinstatement following withdrawal of a member state shall occur upon 534

the withdrawing date reenacting the Compact or upon such later date as determined by 535

the Interstate Commission. 536

(g) The Interstate Commission is authorized to develop rules to address the 537

impact of the withdrawal of a member state on licenses granted in other member states 538

to physicians who designated the withdrawing member state as the state of principal 539

license. 540

SECTION 22. DISSOLUTION 541

(a) The Compact shall dissolve effective upon the date of the withdrawal or 542

default of the member state which reduces the membership of the Compact to one (1) 543

member state. 544

(b) Upon the dissolution of the Compact, the Compact becomes null and void 545

and shall be of no further force or effect, and the business and affairs of the Interstate 546

Commission shall be concluded, and surplus funds shall be distributed in accordance 547

with the bylaws. 548

SECTION 23. SEVERABILITY AND CONSTRUCTION 549

(a) The provisions of the Compact shall be severable, and if any phrase, 550

clause, sentence, or provision is deemed unenforceable, the remaining provisions of the 551

Compact shall be enforceable. 552

(b) The provisions of the Compact shall be liberally construed to effectuate its 553

purposes. 554

(c) Nothing in the Compact shall be construed to prohibit the applicability of 555

other interstate compacts to which the member states are members. 556

SECTION 24. BINDING EFFECT OF COMPACT AND OTHER LAWS 557

(a) Nothing herein prevents the enforcement of any other law of a member 558

state that is not inconsistent with the Compact. 559

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(b) All laws in a member state in conflict with the Compact are superseded to 560

the extent of the conflict. 561

(c) All lawful actions of the Interstate Commission, including all rules and 562

bylaws promulgated by the Commission, are binding upon the member states. 563

(d) All agreements between the Interstate Commission and the member 564

states are binding in accordance with their terms. 565

(e) In the event any provision of the Compact exceeds the constitutional limits 566

imposed on the legislature of any member state, such provision shall be ineffective to 567

the extent of the conflict with the constitutional provision in question in that member 568

state. 569